ALL RADIOLOGISTS:



NEW PQRS MEASURES

ALL RADIOLOGISTS:

1. Measure 405: Appropriate Follow-up Imaging for Incidental Abdominal Lesions: Will measure % of abdominal imaging studies for asymptomatic patients aged 18 years and older with one or more of the following noted incidentally with follow-up imaging recommended:

• Liver lesion ≤ 0.5 cm

• Cystic kidney lesion < 1.0 cm

• Adrenal lesion ≤ 1.0 cm

This measure is satisfied in one of 3 ways:

• Identification of an incidental lesion followed by a specific follow up recommendation with a medical reason (cite ACR criteria) why follow up imaging is appropriate. OR

• Identification of an incidental lesion followed by clear statement that no follow up imaging is necessary. OR

• Report does not document any incidental lesion within a given CT/MRI/Ultrasound of liver, kidney or adrenal imaging

Basically, the ACR does not want us to follow up any of these lesions in patients with low or average risk. Follow up should be recommended in high risk .

Because there are nuances and it contains other specific guidelines, it is important to read the entire ACR white paper which can be found at

(10)00330-3/fulltext.

POWERSCRIBE INCIDENTAL LIVER: {An incidental liver lesion is identified measuring under 5 mm in size. In a patient with low or average risk for malignancy, follow up is not recommended as per ACR recommendations.}

POWERSCRIBE INCIDENTAL ADRENAL: {An incidental adrenal lesion is identified measuring under 1 cm. In a patient with low or average risk for malignancy, follow up is not recommended as per ACR recommendations.}

POWERSCRIBE INCIDENTAL KIDNEY: {An incidental cystic lesion is identified measuring under 1 cm in size. In a patient with low or average risk for malignancy, follow up is not recommended as per ACR recommendations.}

2. Measure 406: Appropriate Follow-up Imaging for Incidental Thyroid Nodules (ITN’s) in Patients: Percentage of final reports for computed tomography (CT) or magnetic resonance imaging (MRI) studies of the chest or neck or ultrasound of the neck for patients aged 18 years and older with no known thyroid disease with a thyroid nodule < 1.0 cm noted incidentally

Applies to CT or MRI studies of the chest and neck as well as ultrasound of the neck for patients aged 18 years and older with no known thyroid disease with a thyroid nodule < 1.0 cm noted incidentally with follow-up imaging recommended.

To be in compliance, the reports of these studies must include one of the following:

1) Identify and document ITN's in the body of the report with appropriate description including measurements and state the evidence based reason (cite ACR guidelines) f/u is recommended. This should also be in the conclusion/impression. OR

2) Identify and document ITN's in the body of the report and state that no f/u is needed. (ACR white paper recommends these not be included in conclusion/impression.) OR

3) No ITN's are found or documented.

Failure to be in compliance would occur if you mention an incidental lesion but fail to clearly state whether or not follow up imaging is recommended. When recommending f/u you must be specific and cite medical reason such as ACR guidelines.

POWERSCRIBE INCIDENTAL THYROID:

[An incidental thyroid nodule is identified measuring under 1 cm in size. Follow up is not recommended as per ACR recommendations, assuming the patient is not high risk for thyroid malignancy.]

Because there are nuances and it contains other specific guidelines, it is important to read the entire ACR white paper on incidental thyroid nodules. For instance, the paper states that any size nodule with suspicious features (invasion of local; abnormal lymph nodes with calcs, cystic components, or hyperenhancement) should be evaluated with US and all decisions must take into consideration underlying risk factors and comorbidities.

Here is the url for the entire paper which you can save as a favorite on your browser:

(14)00627-9/fulltext.

3. Measure 436: Radiation Consideration for Adult CT: Utilization of Dose Lower Techniques

The following must be included in your CT technique sections:

“The kV and/or mA were adjusted according to the patient size and body part for CT dose reduction. ” A macro has been created called: Powerscribe CATSCANDOSE

OLD MEASURES (PLEASE READ CAREFULLY FOR NEW INFORMATION)

ALL RADIOLOGISTS:

4. Measure 145: Exposure Time Reported for Procedures Using Fluoroscopy

Consistently mention radiation exposure indices on any real time fluoro based procedure report:

Exposure (fluoro) time and the number of fluorographic images (additional exposures) taken during the procedure may be used.

5. Measure 195: Stenosis Measurement in Carotid Imaging Reports

All carotid imaging studies (neck MRA, neck CTA, neck duplex ultrasound, carotid angiogram) performed need to include a blanket statement where you measure the Carotid diameter that mentions that "any diameter measurements were based on NASCET Criteria", that should satisfy this measure.

BREAST IMAGERS:

1. Measure 146: Inappropriate Use of “Probably Benign” Assessment Category in Screening Mammograms

No screening mammograms can be classified as “Probably Benign (BIRADS 3)”

2. Measure 225: Reminder System for Screening Mammograms.

Everyone must put a canned statement on all screening mammograms that states an automated system is in place to remind patient when her next mammogram is due.

NUCLEAR MEDICINE IMAGERS:

Measure 147:

| Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy: Percentage of final |

|reports for all patients, regardless of age, undergoing bone scintigraphy that include physician documentation of correlation with |

|existing relevant imaging studies (e.g., x-ray, MRI, CT, etc.) that were performed |

| | | | | |

It is imperative that you make sure to add in all bone scan reports a statement regarding prior comparison to relevant X-ray or cross sectional imaging and pertinent specific positives and negatives. If none available, document in comparison section-None available.

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